Over the past twenty years a variety of investigators have done extensive studies…For more than a century, glaucoma treatment has been directed at lowering intraocular pressure. Recent research is working on a theory that if the optic nerve cells can be ‘protected’ they will be able to withstand the stress of pressure better. This theory is called Neuroprotection. Neuroprotection has emerged as a consequence of many new discoveries in the fields of genetics, neurobiology, and pharmacology. The theory of neuroprotection is to make the nerve cells more robust and to transform the hostile environment created by high pressure to a healthy one. In order for optic nerve cells to function properly they need to be able to receive specific nutrients and oxygen and dispose of the wastes they produce. The cells need growth factors and essential chemicals in the correct proportion or they begin to malfunction. Once cells are damaged several vicious cycles come into play that may make the optic nerve cells more susceptible to further damage. Neuroprotection is aimed at strengthening the optic nerve cells by addressing the imbalance in the way optic nerve cells function.

Too much of a good thing: Some substances are essential for cell functioning. However, if these are present in excess they can overexcite the cell and literally excite the cells to death. One such substance is glutamate. Currently, it is not known what stimulates the increase in glutamate in glaucoma. It is possible that any type of damage, such as glaucoma itself, may result in glutamate release. However, if glutamate release may be controlled, than perhaps it may be possible to prevent the cells from dying.

Too little The optic nerve cells that are affected by glaucoma have a decrease in their supply of crucial growth factors, such as brain-derived neurotrophic factor. Research is aimed at trying to provide additional supply of such growth factors to strengthen the cell.

Preventing cell suicideOne of the ways in which optic nerve cells die is by a process of ‘cell suicide’- known as apoptosis. Once cells receive a message to ‘commit suicide’ they die often prematurely. Research is aimed at delaying or preventing such messages from resulting in cell death.

At the present time there is no proof that there is any way to protect the nerves of patients with glaucoma other than lowering the pressure within the eye. However, we are at the beginning of exciting times in the development of this area of neuroprotection. Neuroprotection may be an important part of treatment for glaucoma in the future.